Meniscal Transplantation

It is well recognized that complete meniscectomy ablates hoop stresses and increases surface strain in articular cartilage and commonly results in arthritis. In addition, in anterior-cruciatedeficient knees, medial meniscectomy increases instability. To reverse these trends, free meniscal transplantation has been developed. To determine the success of this procedure, 43 of these transplantations performed in 1986–1991 were studied prospectively. Patients included 29 men and 14 women, ages 19–42. Seven underwent meniscal transplantation alone, 24 combined with anterior cruciate ligament reconstruction, and 13 combined with osteotomy. Transplantation was performed with arthrotomy. Fresh menisci were used in 16 cases and cryopreserved in 27. Follow-up currently extends from 2 to 7 years. Success was verified directly with arthroscopy in 28 cases, and 15 were clinically “silent” and remain unstudied arthroscopically. Success, as measured by healing of the rim and lack of shrinkage or degeneration, was felt to be achieved in 20 of the 28 cases. Factors associated with unfavorable results were grade-IV articular changes of the femoral condyles, which probably explains the failure in osteotomy cases. Lack of articular congruence, compliance, and smoothness of these knees was considered to be the reason for deterioration of meniscal structure. Meniscal transplantation is felt to be a reasonable undertaking in young patients who have undergone complete meniscectomy, but have grade-IV articular disease.